Management of pediatric occult pneumothorax in blunt trauma: a subgroup analysis of the American Association for the Surgery of Trauma multicenter prospective observational study.

Background: Occult pneumothorax (OPTX) represents air within the pleural space not visible on conventional chest radiographs. Increased use of computed tomography has led to a rise in the detection of OPTX. Optimal management remains undefined.

Blunt traumatic occult pneumothorax: is observation safe?--results of a prospective, AAST multicenter study.

Background: An occult pneumothorax (OPTX) is found incidentally in 2% to 10% of all blunt trauma patients. Indications for intervention remain controversial. We sought to determine which factors predicted failed observation in blunt trauma patients.

Validation of a prehospital trauma triage tool: a 10-year perspective.

Background: Triage of the trauma patient in the field is a complex and challenging issue, especially deciding when to use aeromedical transport. The American College of Surgeons Committee on Trauma recently defined an acceptable under-triage rate [seriously injured patient not taken to a trauma center (TC)] as 5%, whereas over-triage rates may be as high as 25% to 50%. Effective utilization of prehospital helicopter transport requires both accurate assessment of patients and effective communication.

A county hospital surgical practice: a model for acute care surgery.

Background: Trauma surgery has changed significantly over the past decade. Nonoperative evidence-based algorithms have become common and surgical trauma volume has become increasingly difficult to maintain. The acute care surgery (ACS) model, which integrates trauma, critical care, and emergency surgery, has been proposed as a future model of trauma practice.

Barriers to screening for domestic violence in the emergency department.

The identification of victims of domestic violence is important to prevent further abuse and injury. The purposes of this pilot project were to identify potential barriers emergency department registered nurses encounter in screening patients for domestic violence and to assess nurses' educational backgrounds for continuing education and training needs. The most significant potential barriers to screening identified were a lack of education and instruction on how to ask questions about abuse, language barriers between nurses and patients, a personal or family history of abuse, and time issues.

Blunt trauma patients with prehospital pulseless electrical activity (PEA): poor ending assured.

Background: The paucity of information on the outcome of patients experiencing prehospital pulseless electrical activity (PEA) after blunt injury led to the present study.

Methods: A retrospective review was performed of all blunt trauma victims with prehospital PEA from 1997 to 2001 in an urban county trauma system.

Results: One hundred ten patients, 78 men and 32 women, met study criteria.

The utility of helicopter transport of trauma patients from the injury scene in an urban trauma system.

Background: Continuing controversy surrounding the value of scene helicopter evacuation of urban trauma victims led to the present study.

Methods: A retrospective review was performed of all patients brought to our trauma center from the injury scene by helicopter from 1990 to 2001.

Results: The study included 947 consecutive patients, 911 with blunt trauma and 36 with penetrating injuries.

A new operation with inadequate Brescia fistulae for preservation of more proximal veins.

Purpose: The purpose of this study was to test the hypothesis that venous outflow of a Brescia fistula that is patent but unusable for one of a variety of reasons can provide adequate drainage to sustain a prosthetic arteriovenous graft based on the brachial artery, thus sparing more proximal veins for future access procedures.

Methods: The operation consists of placement of a prosthetic graft between the brachial artery in the antecubital space and the cephalic vein at the wrist.

Results: Between December 1998 and November 1999, 14 patients (eight male and six female; age range, 34 to 73 years; mean age, 51 years) underwent the operation.